It’s known as the state’s budget buster, a big public entitlement program whose enrollment is often growing and costs are always rising.
The Massachusetts Medicaid program, known as MassHealth, provides health coverage to more than a quarter of the state population. So, who benefits from the program? A new report attempts to describe these 1.8 million people, as lawmakers prepare to finalize the state budget over the coming weeks.
While it doesn’t recommend policy changes, the report attempts to humanize a program that is often reduced to numbers and statistics.
Most people covered by MassHealth have very low incomes — while living in an expensive state — according to the analysis from the Blue Cross Blue Shield of Massachusetts Foundation. Eighty-five percent of them have incomes of about $16,000 or less per individual, or $28,000 or less for a family of three.
Two-thirds have incomes of about $10,000 or less per individual, or $18,000 or less for a family of three.
That is significantly below the median income in Massachusetts of about $35,000 for an individual, and $104,000 for a three-person household, according to the US Census Bureau.
“We’re talking about people who are struggling with really extreme poverty,” said Audrey Shelto, president of the Blue Cross foundation, which does health policy research.
More than one-third of individuals covered by MassHealth are children, and 10 percent are seniors 65 or older. Many MassHealth members have disabilities.
Among those who reported their race, 61 percent are white, 17 percent are black, and 13 percent are Hispanic. (The rest reported other races). They are from every part of the state.
The report used MassHealth agency data and was developed in partnership with the consulting firm Manatt Health and the advocacy group Health Care For All.
“People hear about this big state and federal program but don’t understand how important a source of insurance it is for many of us in the Commonwealth,” she said. “It’s our neighbors, it’s the people we work with, it’s people in our families.”
MassHealth is expected to cost taxpayers $16.46 billion this fiscal year. About half of the program costs are paid by the state and the rest are paid by the federal government.
“MassHealth is and continues to be an important public insurance program and is part of the reason why Massachusetts has near universal health coverage,” said Sharon Torgerson, a MassHealth spokeswoman.
But MassHealth costs have long been a source of consternation on Beacon Hill. Spending on the program increased more than 30 percent from 2014 to 2018, according to figures provided by program officials. Policy makers and state budget observers note that every additional dollar spent on health care is funding that can’t be used for education, transportation, and other priorities.
Governor Charlie Baker’s administration in 2017 tried to slash MassHealth costs by limiting coverage for some prescription drugs and moving thousands of people off the program. But federal officials and state legislators rejected that plan.
This year, Baker has proposed new measures to tackle a specific area of MassHealth spending, prescription drug costs, by negotiating lower prices for medications and subjecting pharmaceutical companies to new state oversight.
State senators largely supported his proposal in their version of the state budget bill, while House lawmakers backed a weaker version of it. The House and Senate must agree on the details of the drug pricing plan before sending a final version of the overall budget proposal to Baker’s desk.
Enrollment in MassHealth has grown over the past several years as the Affordable Care Act, also known as Obamacare, expanded eligibility and allowed more people to sign up for the program.
But not every state agreed to expand Medicaid coverage, and the program remains controversial nationally. In Washington and in some states, many Republicans support measures to limit Medicaid funding or to limit eligibility by implementing strict work requirements for people seeking coverage.
Joshua Archambault, a senior fellow at the Pioneer Institute, a free market-oriented think tank in Boston, said Massachusetts officials should do more to encourage able-bodied adults to work so they can earn enough money that they don’t need public coverage.
“MassHealth plays an important role for coverage for many vulnerable residents in Massachusetts,” he said. “However, the program is and has been on an unsustainable path for years as it has consumed the state budget, leaving less money for education, public safety, and infrastructure.”
MassHealth pays for a variety of health care services, from hospital visits to home care to nursing homes — though not all health care providers accept MassHealth.
People often float in and out of the program as they move between jobs. One such member is Jessica Oliveira, 28, who relied on MassHealth while working a low-wage Boston hospital job that didn’t offer insurance. Oliveira switched jobs this spring and was able to enroll in health coverage through her new employer, according to the report.
Sal and Kristal Gurgone of Worcester, a welder and a teacher, have depended on MassHealth or other subsidized coverage since Kristal lost her job in 2014, according to the report. The Gurgones have two small children, and MassHealth pays for their primary and pediatric care needs.
“Understanding the MassHealth population — who they are and what role MassHealth plays in their lives — is critical to framing and informing policy and program development,” the report states.